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thyrotoxicosis
- increased thyroid hormone levels
- suppressed TSH levels
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Thyrotoxicosis with radioactive iodine uptake in one lobe
toxic adenoma
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Hashimoto's thyroiditis
- most are hypothyroid or euthyroid
- thyroid scan shows heterogenous pattern
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Graves disease
- diffusely increased radioactive iodine uptake
- eye involvement
- pretibial myxedema
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pan hypopituitarism
clinical presentation
- ACTH deficiency: postural hypotension, tachycardia, fatigue, weight loss, decreased libido, hypoglycemia, eosinophilia
- Hypothyroidism: fatigue, cold intolerance, decreased appetite, constipation, dry skin, bradycardia, delayed DTR, anemia
- Gonadotropins: (women) amenorrhea, infertility, hot flashes; (men) decreased energy and libido
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Pan hypopituitarism
etiology
- primary:
- -pituitary mass
- -pituitary surgery
- -infiltrative: hemochromatosis
- -infarction: Sheehan syndrome
- -empty sella syndrome
- -Apoplexy
- Hypothalamic causes:
- -Benign masses
- -Malignant metastases
- -Radiation for CNS malignancy
- -Infiltrative sarcoidosis
- -trauma
- -infections (TB meningitis
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adrenal insufficiency
- fatigue
- hyperpigmentation
- lower BPs
- eosinophilia
- lower sodium
- hyperkalemia
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evaluation of adrenal insufficiency
- cosyntropin stimulation test with cortisol and ACTH levels
- Basal cortisol low, ACTH high, minimal cortisol response to cosyntropin: primary AI
- Basal cortisol low, ACTH low, minimal or suboptimal cortisol response: secondary or tertiary adrenal insufficiency
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thyroid malignancy
- most common: papillary thyroid cancer (70%)
- worst prognosis: anaplastic carcinoma
- medullary: parafollicular C-cells, typical in MEN 2a and 2b
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Familial hypocalciuric hypercalcemia
- autosomal dominant
- abnormal calcium-sensing receptors on parathyroid cells
- inappropriately high-normal to borderline elevated PTH level
-
Dehydroepiandrosterone-sulfate
DHEA-S
predominantly produced by the adrenal glands
-
Hashimoto's thyroiditis
- anti-thyroperoxidase (TPO) antibodies
- risk: thyroid lymphoma (60x patients without)
- patients may be euthyroid or hypothyroid, or have transient thyrotoxicosis during the initial part of the illness
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Gastroparesis
- >50% of patients with longstanding type 1 or 2 DM
- sx: anorexia, nausea, vomiting, early satiety
- Tx: optimize diabetes control; small, frequent meals
- Metoclopramide: prokinetic, antiemetic properties
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osteomalacia
- causes: malabsorption (vitD most common), intestinal bypass surgery, celiac disease, CKD, chronic liver disease
- Signs/symptoms: asymptomatic, bone pain, muscle cramps, difficulty walking, waddling gait
- Dx: elevated alk phos, elevated PTH, decreased calcium and phosphorus, decreased urinary calcium, decreased vit D
- pseudofractures
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Leydig tumors
- most common type of testicular sex cord stromal tumors
- elevated testosterone and estrogen
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